THIS WEEK'S ARTICLES
Are Orthopedic ORs Clean?
Research reveals problem areas that need to be wiped down during room turnovers.
Surfaces in orthopedic ORs that are often considered clean might actually be covered with contaminants, according to a new study that found concerning levels of bioburden within supposedly sterile surgical environments.
Researchers at Geisinger Medical Center in Danville, Pa., used adenosine triphosphate (ATP) testing to measure levels of bacteria on numerous surfaces in six orthopedic ORs after routine between-case cleaning. Surgical light handles, computer keyboards, equipment buttons and patient positioners were among the dirtiest surfaces. In fact, the level of bioburden found on surgical light handles, patient positioners and the underside of the OR table headboard would not have passed cleanliness standards in restaurants. "This is frankly alarming," say the researchers.
Sampled surfaces that were considered "clean" included draped instrument preparation back tables, the inside of sterilized instrument trays, the inside of forced-air patient warming hoses and the supply storage area countertops.
The danger of contaminated operating room surfaces is heightened during orthopedic procedures involving complex instrumentation, implantable hardware and open incisions, say the researchers, who published their findings in Clinical Orthopaedics and Related Research. They emphasize the importance of including surfaces such as the undersurface of the OR table and machine buttons in routine cleaning protocols to reduce the amount of bioburden in orthopedic ORs.
Routine visual inspections of surfaces are not an effective way to accurately assess bioburden levels in healthcare settings note the researchers, who say the presence of contamination in a sterile OR environment jeopardizes safe patient care. They suggest that more attention needs to be paid to potential problem areas during cleaning between surgical procedures.
Tips for Trimming OR Turnover Times
Perioperative pros share proven ways to ready rooms for the next procedure.
Surgical leaders must give their teams the tools and tips they need to clean ORs between cases as quickly and effectively as possible, says Alicia Rock, BSN, RN, CNOR, interim assistant nurse manager at University of Iowa Hospitals and Clinics in Iowa City.
Ms. Rock suggests observing several room turnovers in action to determine the roles individual staff members play and assess the process for areas of needed improvement, perhaps through better access to needed supplies or streamlined movements and tasks. The exercise proved productive in her facility. "After watching, the issues became obvious," she says. "We were able to narrow them down to things that we'd be able to influence."
Asking turnover team members to describe their responsibilities in detail allows surgical leaders to determine which resources are used most effectively, eliminate wasted movements and identify tasks that could be adjusted or performed more efficiently. Huddling with team members also ensures cleaning roles are clearly identified and communicated, so turnover team members don't reclean areas their colleagues already went over.
Cleaning carts that hold the supplies staff need to turn over rooms — gloves, surface disinfectants, garbage bags, mops and buckets — can be wheeled into rooms to help staff get the job done quickly. Using surface cleaners with short dwell times also helps to speed the process along.
Robert Cerfolio, MD, MBA, chief of clinical thoracic surgery at NYU Langone Health in New York, helped slash average turnover times in the hospital from 37 minutes to 14 minutes. He says recording weekly turnover times and sharing the results with staff members lets them track their progress and improve their performance by breaking free of inefficient processes.
"Change is difficult when surgical teams are used to the routine of room turnovers," says Dr. Cerfolio. "Once they see the value in efficient room turnovers, they'll be able to sustain and scale the process improvement."
A Team Approach for a Cleaner, Safer Environment Means Better Outcomes for Patients
Keeping patients and staff safe in the OR with effective surface disinfection protocols, efficient hand hygiene plans and environmental cleaning procedures yields positive results.
Patients are heading back to the OR for elective surgeries in the nation's hospital outpatient departments and ambulatory surgical centers, and OR leaders are looking at more ways to improve infection prevention and keep patients – and the staff – safe in the OR. We asked James Chia, Senior Director of Research & Development at Metrex, about the renewed focus on surface disinfection and how it can be accomplished effectively.
With Covid-19 still top of mind in all healthcare facilities, what would you want OR teams to keep in mind as they prepare their OR rooms for outpatient surgeries?
Due to the complex and diverse environmental elements (medical devices, facilities, people) in the OR rooms, a comprehensive cleaning procedure should be developed in a team approach. This should range from establishing efficient hand hygiene plans and environmental cleaning/disinfection procedures to building a multidisciplinary team covering expertise such as perioperative leader, infection preventionist, EVS leader, and many more roles. Specifically, for surface disinfection, it is suggested for the cleaning team to use cleaner/disinfectant that has a broad spectrum of activity against the major pathogens AND SARs-CoV2, since we are still in a pandemic and COVID is still here.
What is the overall importance of surface disinfection in the OR and other locations in the ASC and hospital outpatient departments?
Invasive procedures in OR and other locations in the ASCs offer pathways for infection-causing pathogens to enter the body, such as Staphylococcus aureus and/or MRSA, Pseudomonas aeruginosa, etc., and these pathogens can spread and stay infectious on surface for months. OR rooms are not dedicated to one patient but are used multiple times for many patients – thus effective surface disinfection targeting these pathogens could significantly reduce the risk getting infected by directly or indirectly contacting the contaminated surface.
What can OR leaders do to train their teams for the best results in infection prevention?
OR leaders should allow their staff the appropriate turnover time to thoroughly clean and disinfect the equipment and environment for the next patient. It would be ideal to make sure the trainings cover multi-disciplinary expertise such as perioperative leader, infection preventionist, EVS leader and many more roles.
What considerations are important when choosing a surface disinfectant product?
There are several attributes to watch when choosing a surface disinfectant in use. From a clinical perspective, an appropriate surface disinfectant product should cover a broad spectrum of efficacy kill claims against various bacteria, virus, fungi and drug-resistant microorganisms that transmit via a surface. The contact time should be considered when improving turnaround time and compliance are important. From a technical application perspective, the product should have great cleaning performance and decent compatibility with common materials used in medical device such as metal, plastic and ceramics.
How does CaviWipes help in an overall infection prevention program?
CaviWipes stands out among other surface disinfectant products due to its multi-surface material compatibility and fast and easy cleaning efficacy. These two qualities are considered extremely important to the success and effectiveness of surface disinfection and infection prevention in general.
What trends do you see coming up in the future for surface disinfection protocols?
As technology keeps evolving, more applications are developed towards simplifying the workflow in surface disinfection protocols, such as combining cleaning and disinfection into one-step process when no visible soil is present, shortening disinfection contact/dwell time, and broadening efficacy claim coverage for clinically relevant pathogens. Besides, future surface disinfection will require more sustainable and safer chemistries and better user experience. With that being said, cleaning should not be compromised and should still be the focus in surface disinfection, and it will still be a must-have element in the future protocols.
Note: For more information, please visit www.metrex.com.
A New Barrier Against Surgical Site Infections
Incise drapes coated with chlorhexidine gluconate prevent surgical wound contamination.
Adhesive incise drapes coated with chlorhexidine gluconate (CHG) are a novel way to reduce the risk of surgical site infections (SSIs), according to new research. The authors of the study say the drapes prevent recolonization of deep tissue layers and hair follicles after pre-op skin antisepsis.
CHG reduced the risk of bacterial migration into surgical wounds based on a porcine model of surgical wound contamination, according to the study, which was published in the American Journal of Infection Control. The results show drapes containing CHG reduced bacterial counts in surgical incisions and demonstrated significant antimicrobial activity against MRSA contamination of the skin surface.
The CHG drapes showed immediate antimicrobial activity, which according to the researchers suggests fewer skin contaminants could migrate into open wounds. They also note the drapes maintained persistent effectiveness in the presence of blood and organic material.
Surgical professionals have traditionally used conventional or iodophor-based adhesive incise drapes to create a microbial barrier that prevents bacteria from the patient's skin from entering and contaminating the surgical wound, although previous research pointed to the lack of evidence supporting the effectiveness of the practice in preventing SSIs. The authors of the current study say additional clinical, evidence-based studies are needed to determine if CHG antimicrobial incise drapes reduce wound contamination, but believe the drapes could have a significant future role in SSI prevention.
APIC to Advance Infection Control Education
The organization wants to influence the next generation of infection preventionists.
The CDC has tabbed the Association for Professionals in Infection Control and Epidemiology (APIC) to develop educational content for vocational programs, community colleges and public health organizations with the goal of promoting and advancing careers in the field.
The National Network of Public Health Institutes (NNPHI) partnered with the CDC's Project Firstline to award the grant. "APIC is honored to partner with NNPHI to accomplish the goals that CDC has established for Project Firstline," says APIC CEO Devin Jopp, EdD, MS. "Ensuring that our public health workforce has foundational knowledge on core infection control concepts could not be more important given what we are learning from the global pandemic and the need to protect our nation and our world from future infectious disease threats."
As part of the grant, APIC will assess current opportunities in certification and education, and suggest pilot coursework and programs. "Now, more than ever, infection control is critical to delivering safe health care in both traditional and nontraditional healthcare settings, and strengthening our public health system," says Laila Fox, MUP, MPH, senior program manager at NNPHI.
Donna Nucci, RN, MS, CIC, an infection preventionist at Lawrence and Memorial Hospital in New London, Conn., says her colleagues — especially those at small surgery centers — have been working incredibly hard during the pandemic and believes burnout could create a shortage of professionals willing to take on the responsibilities of the high-pressure job. Ms. Nucci believes her field has to find a new generation of providers who are committed to ensuring surgical teams provide safe patient care.
"Moving forward, I think infection preventionists will have to fully understand healthcare policies, reimbursement strategies and comprehensive data analytics," she says.
The work of APIC should help to ensure surgical facilities have access to dedicated professionals who are knowledgeable about infection control principles and enter the field with a passion to provide safe patient care.